National Assembly for Wales

Health, Wellbeing and Local Government Committee

Committee Inquiry into Workforce Planning- Evidence from Chief Inspector of Care and Social Services Inspectorate Wales

Purpose

1. This paper is submitted by the Chief Inspector of Care and Social Services in Wales to inform the Committee’s discussions in relation to the Inquiry into Health and Social Care Workforce Planning.

Introduction

2. On April 1st 2007 the Care Standards Inspectorate for Wales (CSIW) and the Social Services Inspectorate for Wales (SSIW) and their respective functions were brought together to form the Care and Social Services Inspectorate Wales (CSSIW).

3. CSSIW provides a citizen centred regulation and inspection service.  Its aim is to support the improvement of care and social services and early years services in Wales by raising standards, improving the quality of services and promoting best practice through regulation, inspection, evaluation and development work.  It provides professional advice on all social care matters to the Assembly Government.  

4. This role includes supporting the development of good practice on all workforce matters across local authorities and service providers, the management of the Social Care Workforce Development Programme and the provision of professional advice on workforce matters including in relation to the Care Council for Wales.

5. This memorandum does not deal with early years services for children which are subject to different arrangements.

Background

Social Care in Wales

6. Social care services are commissioned by the 22 local authorities in Wales and provided by a wide range of public, private and voluntary agencies and organisations - including local authorities themselves.  A diverse and complex range of services help to enable some of the most vulnerable people in our society to be as independent and safe as possible.  Services range from assessment care management services provided by social work staff in local authorities to domiciliary care, children’s homes and adult care homes.  

  • Over 150,000 people receive care services at any one time
  • Local authorities in Wales now spend in excess of £1 billion on social care per annum
  • More than 60,000 assessments of older people are completed
  • Over 81,000 older people receive some form of care services  
  • Over 12 million hours of home care are delivered to over 20,000 people each year   
  • There are more than 25,000 people over 65 in residential care
  • More than 4,000 children are looked after by local authorities and more than 3,000 of those children are in foster homes
  • Over 2,000 children are on the child protection register
  • 250 children were adopted in 2006 (Social Services Statistics Wales 2005-06, Local Government Data Unit March 2007).

7. These services make an important contribution to society at all levels for those that work in them as well as for those that use services, their friends families and carers.

8. In recent years service challenges and public expectations have increased.  The needs and expectations of those who use services have become more complex as people are enabled to live longer and richer lives in the community and demographic and social changes need to be responded to.  Services have had to become more responsive to the needs of users and carers and be more flexible in their delivery.  There has also been a wide ranging legislative and policy programme aimed at improving outcomes for service users, their families and carers including the setting up of the Care Standards Inspectorate for Wales and the Care Council for Wales to regulate social care service settings and social care staff.

9. Local authorities now focus more directly on their role of assessing need and commissioning services from independent and voluntary providers and working more closely with other public organisations, including NHS Wales on the delivery of services.    The pattern of service provision is changing.   The CSIW annual report 2005-06 indicates that 86% of adult residential care homes, 73% of registered children’s homes and 84% of domiciliary care are provided by independent - largely private - providers.  This major change has a profound impact on how issues in the social care workforce can be tackled.  Social Care is not a national service.

10. The strategy for social services Fulfilled Lives, Supportive Communities published in February 2007 provides for a continuing framework of development and change.  The strategy recognises that vibrant, flexible and responsive social care services - properly integrated with other local services - are essential if we are to build the fabric of our communities and ensure that individuals and families maximise their opportunities and when necessary receive the support they need.

11. At the same time concerns remain about the quality of services to vulnerable people as demonstrated by reports by both the Social Services Inspectorate in relation to local authority social services and the Care Standards Inspectorate in relation to the quality of care provided in regulated settings and more latterly the Care and Social Services Inspectorate.   Particular concerns about securing a stable, competent workforce, skilled, qualified and trained and appropriately checked to ensure that vulnerable people are properly protected have been highlighted.  It is the case that where serious concerns about the quality of a service are highlighted there is accompanying staffing issues.

The Social Care Workforce

12. Social care is a personal service engaging with adults and children in all aspects and at all times of their daily lives.   Services are delivered twenty four hours a day, three hundred and sixty five days a year and staff often work in demanding and challenging situations with people who are experiencing significant difficulties and distress.  Problems often feel intractable.  Social workers are required to make assessments and decisions affecting people's lives and many of the decisions they are required to make affect the rights of individuals and their safety and protection, as well as the safety and protection of the public.   Staff members are the principal resource of providers of social care

13. The social care workforce can be defined as those deployed to plan, manage, review and deliver these complex and diverse services for adults and children in need and their families.  The quality and responsiveness of the services that are provided are directly linked to the quality and sufficiency of the workforce.  The Care Council for Wales is the Assembly’s primary partner in delivering its workforce improvement agenda and in improving standards and protection for social care service users and their carers.   

14. About 70,000 people are employed in social care, which is about 5% of the total workforce in Wales.   

15. On 31st March 2006 19,900 (WTE) staff were employed by local authorities in Wales, less than 30% of the total 70,000 workforce, with 5% of that workforce employed in core social work services.  (Social Services Statistics Wales 2005-06, Local Government Data Unit, March 2007.)

16. The very largest proportion of staff therefore is employed in direct care settings and by private employers.  Shift work and part time working are common and a relatively high proportion of employees have second jobs.  Pay has traditionally been low and significant numbers are paid at the minimum wage.   Many staff are employed on "casual” contracts and do not receive the benefits associated with permanent employment.  80% of those working in the sector are women whilst women make up 45% of the overall workforce in Wales.  Over 60% of the social care workforce is over the age of 35.  Only 15% of the workforce is Welsh speaking compared to 21% of the general population.  (Care Council for Wales 2006, The Social Care Workforce in Wales: Themes and Trends.)

17. We know that some local authorities have recruited social workers from overseas as part of an overall recruitment and retention strategy and there is anecdotal evidence that there are numbers of staff from overseas working in care settings.  The Care Council for Wales is currently undertaking a study on this matter.

18. The workforce is now spread amongst a large number of very different employers ranging from local authority social services departments to small private providers.

Local authorities

19. Employing staff to plan, commission, manage and deliver services including assessment and care management services.  Local authorities themselves are diverse organisations.   Rhondda Cynon Taf employs 1868 (whole time equivalent) staff whilst Torfaen employs (wte) 484.  

Torfaen

Rhondda Cynon Taf

Total Staff

(Whole Time Equivalent)

473

1868
% social work 32% 19%
% residential services 3.3% 23%
% home care 17% 25%

Private employers

20. Largely engaged in the delivery of direct care services usually in regulated settings including children’s day care.  These employers range from large multi national companies operating across the UK to small local providers where the registered owner is also the registered manger and employs less than ten staff.
It is likely that there are in excess of 1,000 private social care employers in Wales.

Voluntary employers

21. Information about voluntary employers is improving as a result of service regulation and better commissioning practice.  However this is a particularly diverse group of employers providing a wide range of services that are often described in different terms to local authority services.  Voluntary employers range from large UK wide charities such as NCH to very local employers providing advice and/or advocacy services to very specific service user groups. The Wales Council for Voluntary Action holds a database of 25,000 voluntary and community organisations. Of these:

  • 13% (3250) are involved in health and social care
  • 12% (3000) are involved with children and families
  • 7% (1750) are involved with people with physical, sensory or learning disability.

The workforce challenges

22. All areas of social care services across all sectors have faced challenges in recruitment and retention in recent years, within the context of an expanding sector. There has been a lack of long term workforce planning, an over focus on recruitment at the expense of retention and very weak links between workforce and service planning.

23. Future Skills Wales research indicates 23% of social care employers holding vacancies with 8% being hard to fill vacancies.  Posts most difficult to fill were care worker posts representing 60% of the hard to fill posts.  Prime causes given were:

  • Not enough people interested in the job (32%)
  • Location of the organisation and poor transport (25%)
  • Low wages on offer (20%)

24. New regulatory regimes in residential and domiciliary services have set standards in relation to the suitability, experience, training and qualifications of staff and managers as well as in relation to management and supervision arrangements.  These have posed particular challenges to the service including the need to ensure that staff are suitable to take up employment in the sector, the provision of comprehensive training and development arrangements and arrangements to support, supervise and manage staff.  

25. These issues are not confined to the direct care workforce.  Local authorities face challenges in recruiting and retaining staff with high level skills in service planning management and commissioning and the challenges faced in recruiting and retaining social workers are well documented.  

26. Social Work in Wales: A Profession to Value, published by the Association of Directors of Social Services (ADSS) in 2005, noted that at the time of the survey undertaken to underpin the report (May 2004):

'there were 379 (social work) vacancies across all services, indicating that 14.8% of posts were not filled.... Almost two-thirds of these vacancies (64.3%) were in children’s services; 18.6% of all children’s services posts were not filled compared to 10.7% of adult services posts. On average, there were 17.2 vacancies per authority, but the number of vacancies ranged from 1 to 59. Children’s services vacancies averaged 11.1 (range 0 to 37) compared to an average of 6.2 vacancies (range 1 to 22) in adult services.’

27. Turnover rates reported in the report averaged 15.0% across all service areas, but ranged from 3.9% to 38.5% between authorities.  Rates were significantly higher in children’s services than in adult services.  The report noted an estimated growth in demand for social workers of 11.7% over the next three years.

28. In a survey to follow up the Profession to Value report findings (September 2006) ADSS reported that vacancy rates had dropped from 14.8% to 12.6% overall and in Children Services from 18.6% to 15.1% and in Adult Services 10.7% to 9.8% and there was a small improvement in turnover rates.   Whilst this demonstrates improvement these figures remain of concern.

29. There are also concerns about the stability and capacity of the senior management and leadership population across the sector.  High turnover rates of managers in care homes and children’s homes have been noted and we know that numbers of local authorities experience difficulties in recruiting and retaining team managers and other senior managers with sufficient experience.  

Addressing the challenges

30. The responsibility for recruiting and retaining a safe, quality workforce to deliver local services, including the setting of terms and conditions and pay levels and for meeting required standards, lies with each individual employer.  Each employer will need to have in place their own comprehensive workforce plan to underpin their business.   Any strategy has to recognise that a centrally controlled approach is not deliverable.  The challenge is to establish frameworks and national standards to support improvement and development and promote a context of partnership and collaboration for action.  

31. Services are usually delivered however as a result of a contract with a local authority, where local authorities have the lead role for commissioning, planning and contracting services to meet local need. They must ensure that there are services available to meet local assessed need as well as ensuring that all services either provided by them or commissioned from other providers are delivered by staff that are safe, suitable and have appropriate skills and qualifications.  Service users themselves are more concerned with the quality and reliability of the service that they receive and the responsiveness of the individual staff member they deal with than with who provides the service.    

32. The framework that has been developed aims to:

  • Support local authorities and other providers in this engaged role
  • Mitigate against the natural competitive nature of the social care sector
  • Promote a strategic, long term partnership approach to workforce planning, management and development at local regional and national level
  • Embed workforce planning  in service planning
  • Support service improvement.

33. This strategic partnership framework is based on national guidance including on workforce planning and training and development and national regulations and standards including the framework for conduct and qualifications set out by the Care Council for Wales.  The framework has been built up and implemented over recent years.  It has been taken forward in partnership at local, regional and national levels and is underpinned by the following key messages:

  • The social care sector in Wales is one sector with one workforce
  • We can only achieve quality services through collaboration not competition
  • The workforce must become an integral part of everyone’s core business
  • Recruitment/retention difficulties can only be resolved via a combination of long term strategic action and individual local initiatives.

34. The framework integrates the three main elements of workforce development and positions quality services as the primary desired objective:

  • service planning and commissioning
  • training and development
  • human resource planning.

35. This partnership model was acknowledged as good practice in Making the Connections and remains fit for purpose within the context of Delivering Beyond Boundaries and Fulfilled Lives, Supportive Communities.

36. There is now a strategic framework in place for workforce planning in Wales which acknowledges the particular roles of all stakeholders and there are strong workforce partnerships emerging at local and regional level.  The Care Council for Wales has established its role and can speak with authority about the social care sector.

37. Specific initiatives taken to support the framework include:

  • Local authorities have been required to develop whole sector workforce plans (June 2004) for all provided and commissioned services in their area, based on guidance "Planning for Caring” issued by SSIW in March 2003.  The key responsibility of the director of social services for these matters has been reinforced by Fulfilled Lives, Supportive Communities
  • The Assembly’s training support grant scheme managed by CSSIW has been modernised to reflect the partnership "one sector” approach to workforce matters, and to give local authorities a lead role in drawing together a plan to meet the identified training and development needs of provided and commissioned services in their area.  These plans flow on from their workforce plans.  The grant programme has been renamed the Social Care Workforce Development Programme (SCWDP).   Planned expenditure on the Social Care Workforce Development Programme for 2006-07 will total £12,142,855.  The grant element, which provides 70% of the cost of the programme, will be £8,500,000.   The grant is provided as a supplement to employers own resources and in addition to mainstream training and skills funding provided by the Assembly Government  
  • Social work training has been reformed to ensure that newly qualified staff are properly equipped for the challenges of the job they are moving into.  The new degree in social work came on stream in Wales in September 2004
  • A bursary scheme for social work students funded by the Welsh Assembly Government and run by Care Council for Wales has also been introduced to encourage more people to come forward for training
  • Ring fenced funding to support trainee and secondment schemes has been provided through the Social Care Workforce Development Programme Grant
  • The Care Council for Wales has led on developing a framework of workforce standards and all care services are aware of the need to work to common standards including practice standards (National Occupational Standards) some of which were developed jointly by the Care Council for Wales and Skills for Health, and which underpin the framework of qualifications developed and reviewed by the Care Council for Wales.  The new joint Health and Social Care Standards enable a more joined up and flexible approach to be taken to both the training and deployment of the workforce
  • Professionalisation of the social care workforce is being taken forward through registration with the Care Council for Wales.   

Outcomes/Progress to date

38. Local authorities have responded positively to the framework although the complexity of the sector and the large numbers and status of very different employers create a number of challenges at a local level.  Reliable data to inform local activity is not routinely available and because of the business status of many providers, much information that would be useful is considered by them to be too commercially sensitive to share.  

39. There was very little experience of private, voluntary and public employers working together and in many places there were some considerable difficulties because of tensions over fee levels and contract issues.  However as time has gone on we have seen this partnership approach develop and whilst progress remains uneven the majority of local authorities now have well established training and development partnerships in place which are delivering results. In some cases the partnerships are broadening out to take forward workforce planning and management more generally although this aspect is definitely less well developed.   The SCWDP partnerships and the regional workforce partnerships are providing a model for cross sector working in other areas, as reported in the Isle of Anglesey and Vale of Glamorgan Joint Reviews published by CSSIW.

40. Partnerships now have much better information available at a local level to support whole sector planning for training and development.  Although not all authorities were able to report whole sector figures in all staff categories in 2005/06 we have sufficient information to be able to report on training and development activity in the wider social care sector for the first time as supported by the 2005/06 SCWDP grant and we are able to report on the involvement of staff employed by other social care providers as well as those from other statutory partner agencies, for example, health, housing and education.

41. The information submitted to CSSIW shows that across all service areas, the SCWDP partnerships are reaching out and implementing a one sector, one workforce approach. There are high levels of attendances at SCWDP supported events by staff from other social care providers, as well as the continued involvement of staff from partner agencies and encouraging levels of qualification attainment.  2005-06 provides base line information against which progress can be monitored in future years.

42. There are some impressive achievements:

  • Just over 4,125 specified qualifications were gained during the year, up by over 90% on the previous year
  • There were just over 99,900 attendances at SCWDP funded events, some 16% up on the previous year
  • There were 16,685 attendances at training events by staff from other social care providers and 10,229 attendances by staff from other agencies
  • Total attendances by staff not directly employed by local authorities is

26,914 which is 27% of the total attendances supported by the grant.

43. This demonstrates the growing impact of the local partnerships and the continued commitment of all those engaged in social care to raising standards through the one sector, one workforce approach.

44. Evidence from broader sources also demonstrates the progress being made.

45. The percentage of qualified staff in local authority residential services rose from 29% on 30th September 2002 to 43% on 31st March 2006 but skills and qualification levels remain unacceptably low.

46. Further confirmation of progress on qualification attainment can be found in figures from the Employers Organisation Quarterly Monitoring of Health and Social Care Award Registration and Certifications (Oct-Dec 2005). These show encouraging signs that the new Health and Social Care awards are proving popular and achievable. The increase in the number of registrations and certifications for Social Care NVQs between 2004 and 2005 is shown below. Certifications for the new award started seven months after their launch and again show encouraging signs of growth.

47. The demand for the places on the social work degree in Wales is now high with up to five applicants per place available.  The numbers qualifying as social workers is also rising.  297 students achieved the DipSW award in 2005/06, an increase of 23% since 2001/02 and 76% of those registered with the Care Council for Wales to work in Wales.   We know that employers are investing in supporting individuals to gain the qualification by adopting a "grow your own approach” which underpins longer term workforce planning strategies. Over thirty percent of students are sponsored by their employer.   

48. We are also seeing a more collaborative approach to cross border working and this has been particularly evident in the planning and delivery of the degree in social work.  

Continuing challenges

49. Whilst progress is being made it lacks depth and spread - and remains slow and disjointed.  We have not yet secured the workforce stability that is needed to deliver quality services.   More staff with higher levels skills and qualifications are needed if outcomes for service users are to be improved.  As demonstrated by CSSIW reports improvements are also needed in employer practices to ensure that staff working in difficult and demanding roles are properly recruited, supported, supervised and managed and are suitable to work in the social care sector.  Every employer needs to strive to be a model employer.  Progress being made on the framework to support training needs to translate to workforce management and local authorities need to extend the role of the SCWDP beyond training to workforce planning and management.  

50. It is only by employing a more open and engaged approach to commissioning and partnership that local authorities and their partners can ensure that the profile and capacity of the care sector and its workforce can meet local need and respond to the modernising agenda set out in Fulfilled Lives, Supported Communities.  Care providers too must embrace the partnership model and ensure that service users needs and safety are at the heart of workforce planning and employment practices.

51. This requires further and continued commitment to and investment in workforce planning, management and development through the cross sector partnership model.   Workforce issues must be embedded in commissioning and planning and must be central to the management of services.  Tackling workforce issues needs long, medium and short term strategies - taken forward in partnership.

52. Achieving this further improvement needs high level, visible and sustained leadership at all levels and in all parts of the sector.  Directors of social services have had their responsibility for leading the workforce agenda confirmed in Fulfilled Lives, Supportive Communities and they will need to consider individually within their own authorities and collectively through the Association of Directors of Social Services (ADSS) how they can continue to advance this aspect of their role.  Providers and managers of care services must also step up their commitment to this agenda - both individually and collectively - and work in partnership to secure the improvements still needed.

53. However if the continuing improvements required are to be secured local authorities need to take a broader view of social care and recognise and respond to the essential contribution it makes to the local wealth, health and well being of the area through their overarching community leadership role.  It is already apparent that the Local Service Boards have recognised social care as a priority.   The benefits for all that will flow from a cohesive and prosperous social care industry should not be underestimated.

Conclusion

54. Securing improvement in the social care workforce needs long term focussed commitment form all stakeholders.  Social care is not a national service and improvement can only be achieved through collaboration and partnership which recognises the individual responsibility of each employer in the sector.  Progress has been made in recent years and a national framework of guidance regulations and standards is being implemented.  

55. In order to continue the progress made to date partnership working needs to be strengthened and deepened and the one sector approach needs to be fully embraced.   Further progress is needed to extend the partnerships in place around training and development to workforce planning and management and workforce issues need to be fully embedded in commissioning and planning strategies.  Local authorities need to give further consideration to the role social care plays in their areas in relation to the broad agenda for improved wealth, health and well being.  

Rob Pickford
Chief Inspector of Care and Social Services